Schizophrenia

* Disclaimer RE: Schizophrenia Treatment

Rittenhouse Psychiatric Associates does not have admitting privileges at local psychiatric hospitals or true 24-7 emergency coverage. Individuals with schizophrenia, schizoaffective disorder, or other psychotic disorders, may benefit from working with providers who have additional resources – for example, providers who work with larger health systems, or are on full-time staff academic hospitals. Schizophrenia and psychosis is a small percentage of our practice for this reason.

If an individual has new-onset symptoms of psychosis, a new diagnosis of schizophrenia, schizoaffective disorder, or psychosis within the last 3 years, a suicide attempt within the last 3 years, a psychiatric hospitalization within 6 months, or a history of involuntary psychiatric admissions, we will not be able to schedule for safety reasons.

We’ve found that programs such as the University of Pennsylvania’s Psychosis Evaluation & Recovery Center (PERC) and Johns Hopkins Early Psychosis Intervention Clinic (EPIC) are better equipped to evaluate, diagnose and stabilize individuals early in their course of illness. We find that they are also more competent to treat those with severe illness. When those programs have waitlists (or if an individual is unable to schedule with those programs) we recommend that you ask them for their recommendations in your community for psychosis treatment. Programs such as these typically maintain lists of providers whom they trust within the community, for the treatment of schizophrenia (and the programs they trust, often have true emergency coverage, admitting privileges and/or additional resources).

We have found that our practice IS an excellent option for patients with schizophrenia who have an established diagnosis, are engaged in treatment, and are looking for long-term providers who are competent in treating moderate severities of mental illness.

What is Schizophrenia?

Schizophrenia is a psychiatric condition where an individual experiences disturbances in thoughts and perceptions, such as hallucinations, delusions, disorganized thinking and disorganized behaviors.

“Positive Symptoms” – Believed to be secondary to excessive dopamine in the Mesolimbic pathway of the central nervous system, in individuals with schizophrenia:

• Hallucinations: Sensory experiences such as hearing, seeing, smelling, feeling or tasting, that are indistinguishable from reality for the person with psychosis, but are actually not real. A person who experiences an auditory hallucination of a voice (for example), may turn in the direction of the voice (as for them, it is localizable in space, outside of their head, just like any other voice), and respond to, or even argue with, the voice.
• Delusions: Fixed, false, and idiosyncratic thoughts that a person with schizophrenia may develop, which may (in their mind) explain feelings of suspicion or paranoia that their illness inflicts them with, or may explain other phenomenon (such as hallucinations) that they experience. An example, would be the delusion that others can hear their thoughts (Audible thoughts), steal their thoughts (thought withdrawal), or plant thoughts into their minds (thought insertion). Additional common delusions occurring in schizophrenia include thought broadcasting (the belief that one’s thoughts are being broadcast (over radio waves for example) and delusional perceptions (assigning an illogical meaning, to a true perception). An example of a delusional perception, would be a person seeing a car’s license plate number, and internalizing it as evidence that they are being monitored.
• Disorganized thoughts or behaviors: Individuals may have trouble organizing their thoughts or behaviors, resulting in jumbled speech, a train of thought that is difficult to follow, or an inability to speak coherently. Examples of disorganized behaviors, would include unusual movements that one might not expect, such as saluting repetitively, turning for no clear reason, or not moving at all (for example, standing still in a crowded area, for extended periods of time).

“Negative symptoms” – Believed to be secondary to diminished levels of dopamine in the Mesocortical pathway of the central nervous system, in individuals with schizophrenia:

• Affect Flattening: Impaired emotional expression
• Alogia: Decreased speech output
• Avolition: Reduced drive to initiate and persist in self-directed purposeful activities
• Anhedonia: Decreased ability to experience pleasure
• Cognitive Deficits: There may be deficits (that can be progressive) in memory, cognition and decision making

Negative symptoms can make it more difficult for individuals with schizophrenia to engage with others socially and/or romantically, function in the academic or work environment, and maintain independence. Medications that target “Positive Symptoms” such as hallucinations and delusions, and decrease dopamine, can worsen negative symptoms. This is why working with an experienced clinician is important, and why multiple medication trials may be necessary when establishing a patient’s treatment regimen.

What is Schizo-Affective Disorder?

Schizoaffective disorder, is a condition where an individual meets criteria for schizophrenia AND they also meet criteria for a mood disorder (such as major depressive disorder or bipolar affective disorder).

• To make the diagnosis of Schizoaffective disorder, a patient must exhibit psychosis outside of the context of mood episodes. For example, if an individual only hears voices, or experiences delusions when they are either manic or depressed, then they do NOT meet criteria for schizo-affective disorder (and rather, they likely have major depressive disorder or bipolar affective disorder, with psychosis.

How Common is Schizophrenia?

Schizophrenia affects approximately 1% of the US population. Schizophrenia affects men and women in roughly equal numbers.

Course of Illness for Schizophrenia – Why to Get Help Early

Age of onset is approximately 15-25 years of age for men, and 25-35 years of age for women. Schizophrenia is rare in children, although it can occur. About 20% of diagnosis occur after the age of 40 or 45.

Research suggests that early treatment of schizophrenia, and a reduction in the severity and number of psychotic episodes, may reduces the future severity of the illness, and improve prognosis. If you, or someone you love may be experiencing psychosis, please do not delay reaching out for help.

About 1/3 of individuals with schizophrenia have a chronic and progressive course of illness, 1/3 of individuals have a chronic course, and 1/3 of individuals have a period of psychosis and a significant reduction (and/or recovery) from symptoms.

Many individuals with schizophrenia are able to manage their symptoms under the supervision of a psychiatrist, with the help of psychiatric medication management, and additional supports.

What is a “Prodrome,” as it relates to Schizophrenia?

Individuals with schizophrenia, often begin to display a prodrome (or constellation of symptoms) approximately 6 months or so (although it can last years), before they begin to experience more significant psychosis (or have their first psychotic “break”). The prodrome period of schizophrenia may include:

• A loss of interest in things that they typically enjoyed.
• Increased social isolation, or decreased interest in social activities and relationships.
• A flattening (or decrease) in effect, or emotional expression.
• Worsening concentration and/or memory. Worsening executive function.
• Decreased energy
• Decreased personal hygiene or interest in how one looks
• The beginning of perceptual distortions (such as hallucinations)
• Inappropriate responses to situations or loved ones
• Others

What are Risk Factors to the Development of Schizophrenia and Psychosis?

• Heavy and/or daily marijuana use during the teenage years, has been shown to increase the risk of the development of schizophrenia.
  • Studies suggest that as many as 30% of cases of schizophrenia, could be prevented by the avoidance of marijuana.
• Genetic: Individuals who have a parent (or other family member) with schizophrenia have a higher risk of the development of schizophrenia than the general population.
• Additional risk factors: Complications during pregnancy and birth, being born during the winter months (Dec-Feb, likely due to increased risk of flu or other illness, during certain periods of brain development), inner city living/ poverty, traumatic brain injury, others.

When Should I get an Evaluation for the Treatment of Schizophrenia?

We recommend that individuals schedule a psychiatric evaluation for schizophrenia, schizoaffective disorder, or psychosis, if they, a family member, or loved one, has any suspicion that the individual is experiencing psychosis, or any symptoms of these illnesses.

Early treatment, and a reduction in total psychotic episodes, may decrease the severity of the patient’s illness and improve their long-term prognosis and outcome. 

*Please see recommended Schizophrenia and Psychosis Programs, in the disclaimer at the top of this page.

What Types of Treatment are Available for Schizophrenia?

Treatment for Schizophrenia, Schizo-Affective Disorder and Psychosis should be tailored to the individual. There is no one-size-fits-all treatment in psychiatry. Your treatment for Schizophrenia may include:

• Medication Management with medications that reduce psychosis. These medications are categorized as “First Generation” and “Second Generation” Anti-Psychotics (SGA’s). Some patients may benefit from injectable anti-psychotic medications, which may improve compliance (therefore improving long-term prognosis).
• Psychotherapy and Behavioral Activation, may be part of your treatment plan.
  • These aspects of treatment may improve compliance, as well as social / occupational functioning. They may also be utilized to improve the patient’s likelihood of independence.

Do You Offer Both In-office and Virtual Online Psychiatric Appointments for the Treatment of Schizophrenia?

Yes, we offer both in-office and virtual online psychiatric appointments for the treatment of Schizophrenia. Of note, please review the disclaimer at the top of this page, for information on appropriateness to schedule with our practice. Additionally, some of our providers require in-office appointments for this service.

Why Choose Rittenhouse Psychiatric Associates?

The providers at Rittenhouse Psychiatric Associates are academically oriented providers, most of whom teach, or have taught, at academic institutions. Our providers are Board Certified Psychiatrists and Psychiatric Nurse Practitioners and we have several licensed and doctoral level therapists and psychologists. We are experienced in working with individuals who struggle with various psychiatric conditions.

• Licensed Therapists and Doctoral Level Psychologists
• Board Certified Psychiatrists and Psychiatric Nurse Practitioners
• Academically Oriented providers, most of whom teach, or have taught, at local Academic Institutions, such as Johns Hopkins Hospital & The University of Pennsylvania.
• Appointments generally available within 2 weeks, for the treatment of schizophrenia.
• In-office and online Virtual Appointments.
• Providers experienced in treating co-occurring psychiatric conditions.
• Providers who are welcoming to all individuals.